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HumanaChoice Florida Giveback H5216-452 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice Florida Giveback H5216-452 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice Florida Giveback H5216-452 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice Florida Giveback H5216-452 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Central and North Florida PPO. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice Florida Giveback H5216-452 (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about HumanaChoice Florida Giveback H5216-452 (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For HumanaChoice Florida Giveback H5216-452 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $150.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $70.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $6700.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $6700.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The HumanaChoice Florida Giveback H5216-452 (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay different copays or coinsurance amounts depending on the drug tier and where you fill your prescription. For example, in the initial coverage phase, you'll pay no copay for preferred generic drugs at a standard pharmacy, and a $20 copay for the same drug at a standard mail pharmacy. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs.
Additional Benefits
The HumanaChoice Florida Giveback H5216-452 (PPO) plan offers a range of benefits with varying costs. Many services have no copay, including primary care visits, routine hearing and vision exams, and many dental services. You will pay a copay for services like inpatient hospital stays, specialist visits, and outpatient services, with costs varying depending on the service.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care, with a copay of $350 for days 1-7 and $0 for days 8-90 for acute care, and a copay of $350 for days 1-5 and $0 for days 6-90 for psychiatric care. Additional days for inpatient hospital-acute have no copay, while non-Medicare covered stays and upgrades for inpatient hospital-acute and additional days and non-Medicare-covered stays for inpatient hospital-psychiatric are not covered.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services with a copay between $0 and $295, observation services with a $350 copay, and ambulatory surgical center (ASC) services with no copay. Outpatient substance abuse services have a copay between $30 and $100 for individual and group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $45 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the HumanaChoice Florida Giveback H5216-452 (PPO) plan, including ground ambulance services with a copay of $190-$240, and air ambulance services with 20% coinsurance, while transportation services to any health-related location are not covered. All ambulance services require prior authorization.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $125 copay, while Urgently Needed Services have a $15 copay; all services have no coinsurance.
Primary Care See details
The HumanaChoice Florida Giveback H5216-452 (PPO) plan covers Primary Care Physician services with no copay, Chiropractic Services with a $15 copay, and Occupational Therapy Services with a copay between $35 and $40. The plan also covers Physician Specialist Services with a $45 copay, Mental Health Specialty Services with a $30 copay, and Physical Therapy and Speech-Language Pathology Services with a copay between $35 and $40. Other Health Care Professional services have a copay between $0 and $45, Psychiatric Services have a $30 copay, Additional Telehealth Benefits have a copay between $0 and $45, and Opioid Treatment Program Services have a copay between $30 and $100. Podiatry Services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services with no copay, annual physical exams with no copay, and additional services, including Fitness Benefit with no copay for Memory Fitness. Other services like Health Education, In-Home Safety Assessment, and Personal Emergency Response System are not covered.
Hearing Services See details
Hearing services include hearing exams with a $45 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a maximum benefit of $500 per ear, and OTC hearing aids are covered with no copay and a maximum benefit of $500 per ear.
Vision Services See details
Vision services include eye exams with a copay of $0-$45, and eyewear with no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered. Routine eye exams, contact lenses, and eyeglasses (lenses and frames) are covered with no copay.
Dental Services See details
Dental Services are covered, with a maximum plan benefit of $2,000 per year. Medicare Dental Services have a $45 copay, and oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, implant services, prosthodontics (removable and fixed), and oral and maxillofacial surgery have no copay. Fluoride treatment and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice Florida Giveback H5216-452 (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 13% coinsurance and no copay, Prosthetics/Medical Supplies with 20% coinsurance and no copay, and Diabetic Equipment with varying coinsurance and copay amounts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, with a copay for Medicare-covered diagnostic procedures, tests, and lab services, as well as a coinsurance for Medicare-covered lab services. Diagnostic Procedures/Tests have a maximum copay of $150 and at least 20% coinsurance, while Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $295, Therapeutic Radiological Services have a maximum copay of $45 and at least 20% coinsurance, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered under the HumanaChoice Florida Giveback H5216-452 (PPO) plan with no copay and no coinsurance, though additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover the services. The plan requires prior authorization.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice Florida Giveback H5216-452 (PPO) plan. There is no copay for days 1-20, and a $160 copay for days 21-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
The HumanaChoice Florida Giveback H5216-452 (PPO) plan covers acupuncture with no copay, but requires prior authorization and is limited to 25 treatments per year. The plan also covers a meal benefit with no copay, but does not cover Over-the-Counter (OTC) items, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, or Self-Directed Personal Assistance Services.
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